Beyond the GRACE ACS Score: Do We Need a Different Model for Men and Women after STEMI?

Author:

Silva José Sergio Nascimento1ORCID,Barros Isly Maria Lucena de2ORCID,Guimarães Jorge Augusto Nunes2ORCID,Cao Davide3,Martins Sílvia Marinho4ORCID,Carvalho Tawanna Xavier Marques de2,Farias Rayssa Santana de2,Lemke Viviana5ORCID,Mehran Roxana6,Pedrosa Rodrigo2ORCID

Affiliation:

1. Universidade de Pernambuco, Brasil; Hospital Agamenon Magalhães, Brasil

2. Universidade de Pernambuco, Brasil

3. Icahn School of Medicine at Mount Sinai, EUA

4. Universidade de Pernambuco, Brasil; Real Hospital Português de Beneficência em Pernambuco, Brasil

5. Cardiocare Clínica Cardiológica, Brasil

6. Icahn School of Medicine at Mount Sinai Zena, EUA

Abstract

Abstract Background Women, in comparison to men, experience worse outcomes after acute coronary syndrome (ACS). However, whether the female sex per se is an independent predictor of such adverse events remains unclear. Objective This study aims to assess the association between the female sex and in-hospital mortality after ST-elevation myocardial infarction (STEMI). Methods We conducted a retrospective cohort study by enrolling consecutive STEMI patients admitted to a tertiary hospital from January 2018 to February 2019. All patients were treated per current guideline recommendations. Multivariable logistic regression models were applied to evaluate in-hospital mortality using GRACE variables. Model accuracy was evaluated using c-index. A p-value < 0.05 was statistically significant. Results Out of the 1678 ACS patients, 709 presented with STEMI. The population consisted of 36% women, and the median age was 61 years. Women were older (63.13 years vs. 60.53 years, p = 0.011); more often presented with hypertension (75.1% vs. 62.4%, p = 0.001), diabetes (42.2% vs. 27.8%, p < 0.001), and hyperlipidemia (34.1% vs. 23.9%, p = 0.004); and were less likely to undergo percutaneous coronary intervention (PCI) via radial access (23.7% vs. 46.1%, p < 0.001). In-hospital mortality rate was significantly higher in women (13.2% vs. 5.6%, p = 0.001), and the female sex remained at higher risk for in-hospital mortality (OR 2.79, 95% CI 1.15–6.76, p = 0.023). A multivariate model including age, sex, systolic blood pressure, cardiac arrest, and Killip class was 94.1% accurate in predicting in-hospital mortality, and the c-index was 0.85 (95% CI 0.77–0.93). Conclusion After adjusting for the risk factors in the GRACE prediction model, women remain at higher risk for in-hospital mortality.

Publisher

Sociedade Brasileira de Cardiologia

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